Zusammenfassung
Im vorliegenden Artikel werden spezifische Komplikationen nach refraktivem Linsenaustausch (RLA) vorgestellt. Das gesamte Komplikationsspektrum des RLA entspricht weitgehend dem der Kataraktchirurgie; im Unterschied zur Kataraktchirurgie werden jedoch beim RLA besonders kurze oder besonders lange Augen behandelt und das Durchschnittsalter der Patienten ist deutlich geringer. Es werden vor dem Hintergrund dieser Sondersituation in dem vorliegenden Artikel speziell das Risiko von Netzhautpathologien nach myopem RLA erörtert und beim hyperopen RLA typische, durch das kurze Vordersegment bedingte, operative Schwierigkeiten dargestellt. Moderne Kleinschnittchirurgie mit Verwendung faltbarer Intraokularlinsen und scharfer Kantenstruktur zur Reduzierung einer Nachstarbildung zusammen mit einem optimalen postoperativen Management können einer Minimierung RLA-spezifischer Komplikationen Rechnung tragen. Zusammenfassend ist der RLA zur Korrektur hoher Ametropien in der presbyopen Altersgruppe derzeit trotz einer geringen Komplikationsrate eine sichere und effektive refraktive Therapieoption.
Abstract
This overview discusses specific complications after refractive lens exchange (RLE). The complication spectrum is similar to that following cataract surgery, with some differences: RLE is implemented in very short or very long eyes, and the average patient age is significantly lower. Regarding specific situations, this article particularly considers the risks of retinal pathologies after myopic RLE and reviews the typical intraoperative difficulties induced by a short anterior segment in hyperopic RLE. Modern microincisional surgery and the use of foldable intraocular lenses with a sharp edge design reduce posterior capsule opacification and, together with optimal postoperative management, may reduce RLE-specific complications. In summary, despite the minor complication rate, RLE for the correction of high ametropias in the presbyopic age group is a safe and effective refractive treatment option.
Literatur
Fukala V (1890) Behandlung der höchstgradigen Myopie durch Aphakie. Graefes Arch Ophthalmol 36: 230–244
Fischer E (1899) Operation der Kurzsichtigkeit und Ablösung der Netzhaut. Centralbl Augenheilkd 23: 79
Fröhlich C (1899) Über spontane und postoperative Kurzsichtigkeitsnetzhautablösungen. Arch Augenheilkd 38: 11–26
Kohnen T, Knorz MC, Neuhann T (2007) Evaluation and quality assurance of refractive surgery procedures by the german ophthalmological society and the professional association of german ophthalmologists. Ophthalmologe 104(8): 719–726
Kohnen T, Wang L, Friedman N, Koch D (2004) Complications of Cataract Surgery. In: Ophthalmology 2nd edition
Patwardhan A, Rao GP, Saha K, Craig EA (2006) Incidence and outcomes evaluation of endophthalmitis management after phacoemulsification and 3-piece silicone intraocular lens implantation over 6 years in a single eye unit. J Cataract Refract Surg 32(6): 1018–1021
Results of the Endophthalmitis Vitrectomy Study (1995) A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol 113(12): 1479–1496
Lundstrom M, Wejde G, Stenevi U et al. (2007) Endophthalmitis after cataract surgery: a nationwide prospective study evaluating incidence in relation to incision type and location. Ophthalmology 114(5): 866–870
(2007) Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg 33(6): 978–988
Ceschi GP, Artaria LG (1998) Clear lens extraction (CLE) for correction of high grade myopia. Klin Monatsbl Augenheilkd 212(5): 280–282
Gabric N, Dekaris I, Karaman Z (2002) Refractive lens exchange for correction of high myopia. Eur J Ophthalmol 12(5): 384–387
Guell JL, Rodriguez-Arenas AF, Gris O et al. (2003) Phacoemulsification of the crystalline lens and implantation of an intraocular lens for the correction of moderate and high myopia: four-year follow-up. J Cataract Refract Surg 29(1): 34–38
Speaker MG, Guerriero PN, Met JA et al. (1991) A case-control study of risk factors for intraoperative suprachoroidal expulsive hemorrhage. Ophthalmology 98(2): 202–209; discussion 10
Kim HK, Shin JP (2008) Capsular block syndrome after cataract surgery: clinical analysis and classification. J Cataract Refract Surg 34(3): 357–363
O’Grady RB (1971) Nanophthalmos. Am J Ophthalmol 71(6): 1251–1253
Polkinghorne PJ, Craig JP (2004) Northern New Zealand Rhegmatogenous Retinal Detachment Study: epidemiology and risk factors. Clin Experiment Ophthalmol 32(2): 159–163
Perkins ES (1979) Morbidity from myopia. Sight Sav Rev 49(1): 11–19
Grossniklaus HE, Green WR (1992) Pathologic findings in pathologic myopia. Retina 12(2): 127–133
Morita H, Funata M, Tokoro T (1995) A clinical study of the development of posterior vitreous detachment in high myopia. Retina 15(2): 117–124
Celorio JM, Pruett RC (1991) Prevalence of lattice degeneration and its relation to axial length in severe myopia. Am J Ophthalmol 111(1): 20–23
Pierro L, Camesasca FI, Mischi M, Brancato R (1992) Peripheral retinal changes and axial myopia. Retina 12(1): 12–17
Russell M, Gaskin B, Russell D, Polkinghorne PJ (2006) Pseudophakic retinal detachment after phacoemulsification cataract surgery: Ten-year retrospective review. J Cataract Refract Surg 32(3): 442–445
Erie JC, Raecker MA, Baratz KH et al. (2006) Risk of retinal detachment after cataract extraction, 1980-2004: a population-based study. Ophthalmology 113(11): 2026–2032
Onal S, Gozum N, Gucukoglu A (2004) Visual results and complications of posterior chamber intraocular lens implantation after capsular tear during phacoemulsification. Ophthalmic Surg Lasers Imaging 35(3): 219–224
Sharma MC, Chan P, Kim RU, Benson WE (2003) Rhegmatogenous retinal detachment in the fellow phakic eyes of patients with pseudophakic rhegmatogenous retinal detachment. Retina 23(1): 37–40
Tielsch JM, Legro MW, Cassard SD et al. (1996) Risk factors for retinal detachment after cataract surgery. A population-based case-control study. Ophthalmology 103(10):1537–1545
Alio JL, Ruiz-Moreno JM, Shabayek MH et al. (2007) The risk of retinal detachment in high myopia after small incision coaxial phacoemulsification. Am J Ophthalmol 144(1): 93–98
Alldredge CD, Elkins B, Alldredge OC jr (1998) Retinal detachment following phacoemulsification in highly myopic cataract patients. J Cataract Refract Surg 24(6): 777–780
Arraes J, Diniz JR, Escariao P et al. (2006) Clear lens extraction: visual outcomes and vitreoretinopathy frequence. Arq Bras Oftalmol 69(5): 671–674
Barraquer C, Cavelier C, Mejia LF (1994) Incidence of retinal detachment following clear-lens extraction in myopic patients. Retrospective analysis. Arch Ophthalmol 112(3): 336–339
Chastang P, Ruellan YM, Rozenbaum JP et al. (1998) Phacoemulsification for visual refraction on the clear lens. Apropos of 33 severely myopic eyes. J Fr Ophtalmol 21(8): 560–566
Colin J, Robinet A (1994) Clear lensectomy and implantation of low-power posterior chamber intraocular lens for the correction of high myopia. Ophthalmology 101(1): 107–112
Colin J, Robinet A (1997) Retinal detachment after clear lens extraction in 41 eyes with high axial myopia. Retina 17(1): 78–79
Colin J, Robinet A, Cochener B (1999) Retinal detachment after clear lens extraction for high myopia: seven-year follow-up. Ophthalmology 106(12): 2281–2284; discussion 5
Fan DS, Lam DS, Li KK (1999) Retinal complications after cataract extraction in patients with high myopia. Ophthalmology 106(4): 688–91 discussion 91–92
Fernandez-Vega L, Alfonso JF, Villacampa T (2003) Clear lens extraction for the correction of high myopia. Ophthalmology 110(12): 2349–2354
Fink AM, Gore C, Rosen ES (2000) Refractive lensectomy for hyperopia. Ophthalmology 107(8): 1540–1548
Fritch CD (1998) Risk of retinal detachment in myopic eyes after intraocular lens implantation: a 7 year study. J Cataract Refract Surg 24(10): 1357–1360
Gris O, Guell JL, Manero F, Muller A (1996) Clear lens extraction to correct high myopia. J Cataract Refract Surg 22(6):686–689
Horgan N, Condon PI, Beatty S (2005) Refractive lens exchange in high myopia: long term follow up. Br J Ophthalmol 89(6): 670–672
Jacobi FK, Hessemer V (1997) Pseudophakic retinal detachment in high axial myopia. J Cataract Refract Surg 23(7): 1095–1102
Jahn CE, Richter J, Jahn AH et al. (2003) Pseudophakic retinal detachment after uneventful phacoemulsification and subsequent neodymium: YAG capsulotomy for capsule opacification. J Cataract Refract Surg 29(5): 925–929
Jimenez-Alfaro I, Miguelez S, Bueno JL, Puy P (1998) Clear lens extraction and implantation of negative-power posterior chamber intraocular lenses to correct extreme myopia. J Cataract Refract Surg 24(10): 1310–1316
Kohnen S, Brauweiler P (1996) First results of cataract surgery and implantation of negative power intraocular lenses in highly myopic eyes. J Cataract Refract Surg 22(4): 416–420
Kolahdouz-Isfahani AH, Rostamian K, Wallace D, Salz JJ (1999) Clear lens extraction with intraocular lens implantation for hyperopia. J Refract Surg 15(3): 316–323
Ku WC, Chuang LH, Lai CC (2002) Cataract extraction in high myopic eyes. Chang Gung Med J 25(5): 315–320
Lee KH, Lee JH (1996) Long-term results of clear lens extraction for severe myopia. J Cataract Refract Surg 22(10): 1411–1415
Liang D, Chen J (1997) The incidence of retinal detachment after extracapsular cataract extraction in high myopia. Yan Ke Xue Bao 13(2): 90–92
Liesenhoff O, Kampik A (1994) Risk of retinal detachment in pseudophakia and axial myopia. Ophthalmologe 91(6): 807–810
Lyle WA, Jin GJ (1996) Phacoemulsification with intraocular lens implantation in high myopia. J Cataract Refract Surg 22(2): 238–242
Lyle WA, Jin GJ (1997) Clear lens extraction to correct hyperopia. J Cataract Refract Surg 23(7): 1051–1056
Martinez-Castillo V, Boixadera A, Verdugo A et al. (2005) Rhegmatogenous retinal detachment in phakic eyes after posterior chamber phakic intraocular lens implantation for severe myopia. Ophthalmology 112(4): 580–585
Nissen KR, Fuchs J, Goldschmidt E et al. (1998) Retinal detachment after cataract extraction in myopic eyes. J Cataract Refract Surg 24(6): 772–776
Pokroy R, Pollack A, Bukelman A (2002) Retinal detachment in eyes with vitreous loss and an anterior chamber or a posterior chamber intraocular lens: comparison of the incidence. J Cataract Refract Surg 28(11): 1997–2000
Powell SK, Olson RJ (1995) Incidence of retinal detachment after cataract surgery and neodymium: YAG laser capsulotomy. J Cataract Refract Surg 21(2): 132–135
Pucci V, Morselli S, Romanelli F et al. (2001) Clear lens phacoemulsification for correction of high myopia. J Cataract Refract Surg 27(6): 896–900
Ravalico G, Michieli C, Vattovani O, Tognetto D (2003) Retinal detachment after cataract extraction and refractive lens exchange in highly myopic patients. J Cataract Refract Surg 29(1): 39–44
Sheu SJ, Ger LP, Chen JF (2006) Axial myopia is an extremely significant risk factor for young-aged pseudophakic retinal detachment in taiwan. Retina 26(3): 322–327
Siganos DS, Siganos CS, Pallikaris IG (1994) Clear lens extraction and intraocular lens implantation in normally sighted hyperopic eyes. J Refract Corneal Surg 10(2): 117–121; discussion 22–24
Siganos DS, Pallikaris IG (1998) Clear lensectomy and intraocular lens implantation for hyperopia from +7 to +14 diopters. J Refract Surg 14(2): 105–113
Tosi GM, Casprini F, Malandrini A et al. (2003) Phacoemulsification without intraocular lens implantation in patients with high myopia: long-term results. J Cataract Refract Surg 29(6): 1127–1131
Tsai CY, Chang TJ, Kuo LL et al. (2008) Visual outcomes and associated risk factors of cataract surgeries in highly myopic Taiwanese. Ophthalmologica 222(2): 130–135
Uhlmann S, Wiedemann P (2006) Refractive lens exchange combined with pars plana vitrectomy to correct high myopia. Eye 20(6): 655–660
Vicary D, Sun XY, Montgomery P (1999) Refractive lensectomy to correct ametropia. J Cataract Refract Surg 25(7): 943–948
Wang J, Shi Y (2001) Clear lens extraction with phacoemulsification and posterior chamber intraocular lens implantation for treatment of high myopia. Zhonghua Yan Ke Za Zhi 37(5): 350–354
Wang W, Yang G, Nin W, Fang J (1998) Phacoemulsification in myopia and negative or low powered posterior chamber intraocular lens implantation. Zhonghua Yan Ke Za Zhi 34(4): 294–297
Ramos M, Kruger EF, Lashkari K (2002) Biostatistical analysis of pseudophakic and aphakic retinal detachments. Semin Ophthalmol 17(3–4): 206–213
Javitt JC (1994) Clear-lens extraction for high myopia. Is this an idea whose time has come? Arch Ophthalmol 112(3): 321–323
Norregaard JC, Thoning H, Andersen TF et al. (1996) Risk of retinal detachment following cataract extraction: results from the International Cataract Surgery Outcomes Study. Br J Ophthalmol 80(8): 689–693
Javitt JC, Tielsch JM, Canner JK et al. (1992) National outcomes of cataract extraction. Increased risk of retinal complications associated with Nd:YAG laser capsulotomy. The Cataract Patient Outcomes Research Team. Ophthalmology 99(10): 1487–97; discussion 97–98
Baratz KH, Cook BE, Hodge DO (2001) Probability of Nd:YAG laser capsulotomy after cataract surgery in Olmsted County, Minnesota. Am J Ophthalmol 131(2): 161–166
Van Westenbrugge JA, Gimbel HV, Souchek J, Chow D (1992) Incidence of retinal detachment following Nd:YAG capsulotomy after cataract surgery. J Cataract Refract Surg 18(4): 352–355
Skolnick KA, Perlman JI, Long DM, Kernan JM (2000) Neodymium:YAG laser posterior capsulotomies performed by residents at a Veterans Administration Hospital. J Cataract Refract Surg 26(4): 597–601
Dardenne MU, Gerten GJ, Kokkas K, Kermani O (1989) Retrospective study of retinal detachment following neodymium:YAG laser posterior capsulotomy. J Cataract Refract Surg 15(6): 676–680
Koch DD, Liu JF, Gill EP, Parke DW 2nd (1989) Axial myopia increases the risk of retinal complications after neodymium-YAG laser posterior capsulotomy. Arch Ophthalmol 107(7): 986–990
Rickman-Barger L, Florine CW, Larson RS, Lindstrom RL (1989) Retinal detachment after neodymium:YAG laser posterior capsulotomy. Am J Ophthalmol 107(5): 531–536
Behrendt S, Giess L, Duncker G (1991) Incidence of retinal detachment after treatment with the Nd:YAG laser. Fortschr Ophthalmol 88(6): 809–811
Ranta P, Kivela T (1998) Retinal detachment in pseudophakic eyes with and without Nd:YAG laser posterior capsulotomy. Ophthalmology 105(11): 2127–2133
Ranta P, Tommila P, Immonen I et al. (2000) Retinal breaks before and after neodymium:YAG posterior capsulotomy. J Cataract Refract Surg 26(8): 1190–1197
Olsen G, Olson RJ (2000) Update on a long-term, prospective study of capsulotomy and retinal detachment rates after cataract surgery. J Cataract Refract Surg 26(7): 1017–1021
Winslow RL, Taylor BC (1985) Retinal complications following YAG laser capsulotomy. Ophthalmology 92(6): 785–789
Rosen E (2006) Risk management for rhegmatogenous retinal detachment following refractive lens exchange and phakic IOL implantation in myopic eyes. J Cataract Refract Surg 32(5): 697–701
Oldendoerp J (1989) Retinal detachment following neodymium YAG laser capsulotomy in aphakic and pseudo-aphakic eyes. Klin Monatsbl Augenheilkd 194(4): 234–240
Ober RR, Wilkinson CP, Fiore JV jr, Maggiano JM (1986) Rhegmatogenous retinal detachment after neodymium-YAG laser capsulotomy in phakic and pseudophakic eyes. Am J Ophthalmol 101(1): 81–89
Kanski JJ, Daniel R (1975) Prophylaxis of retinal detachment. Am J Ophthalmol 79(2): 197–205
Bonnet M, Aracil P, Carneau F (1987) Rhegmatogenous retinal detachment after prophylactic argon laser photocoagulation. Graefes Arch Clin Exp Ophthalmol 225(1): 5–8
Colin J, Robinet A (1997) Clear lensectomy and implantation of a low-power posterior chamber intraocular lens for correction of high myopia: a four-year follow-up. Ophthalmology 104(1): 73–77; discussion 7–8
Hardman Lea SJ, Rubinstein MP, Snead MP, Haworth SM (1990) Pseudophakic accommodation? A study of the stability of capsular bag supported, one piece, rigid tripod, or soft flexible implants. Br J Ophthalmol 74(1): 22–25
Gonzalez F, Capeans C, Santos L et al. (1992) Anteroposterior shift in rigid and soft implants supported by the intraocular capsular bag. Graefes Arch Clin Exp Ophthalmol 230(3): 237–239
Fukuyama M, Oshika T, Amano S, Yoshitomi F (1999) Relationship between apparent accomodation and corneal multifocality in pseudophakic eyes. Ophthalmology 106(6):1178–1181
Kohnen T, Kook D, Auffarth GU, Derhartunian V (2008) Use of multifocal intraocular lenses and criteria for patient selection. Ophthalmologe 105(6): 527–532
Interessenkonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kook, D., Kampik, A. & Kohnen, T. Komplikationen des refraktiven Linsenaustausches. Ophthalmologe 105, 1005–1012 (2008). https://doi.org/10.1007/s00347-008-1829-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00347-008-1829-5